Neoadjuvant Nivolumab and Ipilimumab for Nonmetastatic Renal Cell Carcinoma with Tumor Thrombus

Master, Viraj A.; Schmeusser, Benjamin; Osunkoya, Adeboye O.; Palacios, Arnold R.; Midenberg, Eric; Yantorni, Lauren; Ogan, Kenneth; Bilen, Mehmet Asım

doi:10.36401/jipo-22-16

Cited by 8 publications

(6 citation statements)

References 29 publications

(28 reference statements)

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“…The patient underwent complete resection of the TT and renal mass. At present, he is one year post-surgery and continues to have no evidence of recurrence on imaging [32].…”

Section: Tyrosine Kinase Inhibitors and Immunotherapymentioning

confidence: 90%

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The Role of Anticoagulation in Tumor Thrombus Associated with Renal Cell Carcinoma: A Literature Review

Williams,

Myint

2023

Cancers

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Tumor thrombus (TT) is a complication of renal cell carcinoma (RCC) for which favorable medical management remains undefined. While radical nephrectomy has been shown to increase overall survival in RCC patients, surgical interventions such as cardiopulmonary bypass (CPB) and deep hypothermic circulatory arrest (DHCA) utilized to perform TT resection carry high mortality rates. While it has been documented that RCC with TT is associated with venous thromboembolism (VTE) development, anticoagulation use in these patients remains controversial in clinical practice. Whether anticoagulation is associated with improved survival outcomes remains unclear. Furthermore, if anticoagulation is initiated, there is limited evidence for whether direct oral anticoagulants (DOACs), heparin, or warfarin serve as the most advantageous choice. While the combination of immunotherapy and tyrosine kinase inhibitors (TKIs) has been shown to improve the outcomes of RCC, the clinical benefits of this combination are not well studied prospectively in cases with TT. In this literature review, we explore the challenges of treating RCC-associated TT with special attention to anticoagulation. We provide a comprehensive overview of current surgical and medical approaches and summarize recent studies investigating anticoagulation in RCC patients undergoing surgery, targeted therapy, and/or immunotherapy. Our goal is to provide clinicians with updated clinical insight into anticoagulation for RCC-associated TT patients.

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“…The patient underwent complete resection of the TT and renal mass. At present, he is one year post-surgery and continues to have no evidence of recurrence on imaging [32].…”

Section: Tyrosine Kinase Inhibitors and Immunotherapymentioning

confidence: 90%

“…In another case report, a 67-year-old male with grade IV TT and RCC was treated with dual checkpoint inhibitor immunotherapy with nivolumab and ipilimumab [32]. Following one year of treatment, his TT had decreased in size; however, it had not regressed from the right atrium.…”

Section: Tyrosine Kinase Inhibitors and Immunotherapymentioning

confidence: 99%

The Role of Anticoagulation in Tumor Thrombus Associated with Renal Cell Carcinoma: A Literature Review

Williams,

Myint

2023

Cancers

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“…A noteworthy study by Master et al in 2023 showcased the successful use of ipilimumab and nivolumab in nonmetastatic RCC with tumor thrombus in the neoadjuvant setting [14]. This intervention led to a decrease in tumor size, with no severe immune adverse events.…”

Section: Discussionmentioning

confidence: 99%

Management of Renal Cell Carcinoma With Supradiaphragmatic Inferior Vena Cava Thrombus Diagnosed During Acute COVID-19 Infection

Leyderman,

McElree,

Nepple

et al. 2024

Cureus

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Renal cell carcinoma (RCC) tends to undergo intravascular tumor growth along the renal vein, forming tumor thrombi that may extend into the inferior vena cava (IVC) or even the right atrium (Level IV). Managing such cases requires a multidisciplinary approach, especially in patients with acute coronavirus disease 2019 (COVID-19) infection, who face increased risks from surgical interventions. We present a case of RCC with Level IV thrombus and concurrent COVID-19 managed with systemic therapy. We also summarize current literature on treating RCC with IVC thrombus and COVID-19's impact on prognosis. The patient was a 70-year-old female with incidental detection of a 9-cm right heterogeneous renal mass with a supradiaphragmatic tumor thrombus during COVID-19 infection. Due to ongoing pulmonary symptoms, systemic therapy with a combination of ipilimumab and nivolumab was initiated. After an excellent initial response, the patient continued systemic therapy, maintaining a necrotic response in the renal mass and tumor thrombus. The patient continues to tolerate systemic therapy well. We report a rare case of RCC with Level IV tumor thrombus and synchronous acute COVID-19 infection. Our report depicts successful management utilizing systemic therapy with a combination of ipilimumab and nivolumab. The management of such cases necessitates a comprehensive, multidisciplinary approach, considering the risks associated with surgery in the context of recent COVID-19 infection. The case presentation and ensuing literature discussion of the dynamic landscape of RCC management highlights the need for more research to improve treatment plans and guide clinicians in handling such complex situations.

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“…An important consideration in this cohort of patients with locally advanced disease is the utility of effective systemic therapy (i.e., immune-checkpoint inhibitors [ICI], tyrosine kinase inhibitors) in the neoadjuvant or adjuvant setting. While neoadjuvant therapy prior to nephrectomy has been reported as feasible (9)(10)(11), our patient cohort only received adjuvant systemic therapy since neoadjuvant systemic therapy outside of clinical trials is currently not routinely used for nonmetastatic RCC. Patients not receiving any systemic therapy actually experienced better survival, likely as a result of patient selection.…”

Section: Discussionmentioning

confidence: 99%

Mayo Adhesive Probability Score Does Not Have Prognostic Ability in Locally Advanced Renal Cell Carcinoma

Schmeusser

Manalo

Liu

et al. 2023

jkcvhl

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Nephrectomy remains standard treatment for renal cell carcinoma (RCC). The Mayo Adhesive Probability (MAP) score is predictive of adherent perinephric fat and associated surgical complexity, and is determined by assessing perinephric fat and stranding. MAP has additionally predicted progression-free survival (PFS), though primarily reported in stage T1-T2 RCC. Here, we examine MAP’s ability to predict overall survival (OS) and PFS in T3-T4 RCC. From our prospectively maintained RCC database, patients that underwent radical nephrectomy (2009-2016) with available abdominal imaging (<90 days preop) and T3/T4 RCC underwent MAP scoring. Survival analyses were conducted with MAP scores as individual (0-5) and dichotomized (0-3 vs 4-5) using Kaplan-Meier method. Multivariable Cox proportional hazard regression models for PFS and OS were built with backward elimination. 141 patients were included. 134 (95%) and 7 (5%) had pT3 and pT4 disease, respectively. 46.1% of patients had an inferior vena cava thrombus. Mean MAP score was 3.22±1.52, with 75 (53%) patients having a score between 0-3 and 66 (47%) having a score of 4-5. Both male gender (p=0.006) and clear cell histology (p=0.012) were associated with increased MAP scores. On Kaplan-Meier and multivariable analysis, no significant associations were identified between MAP and PFS (HR=1.01, 95% CI 0.85-1.20, p=0.93) or OS (HR=1.01, 95% CI 0.84-1.21, p=0.917). In this cohort of patients with locally advanced RCC, high MAP scores were not predictive of worse PFS or OS.

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Neoadjuvant Nivolumab and Ipilimumab for Nonmetastatic Renal Cell Carcinoma with Tumor Thrombus

Cited by 8 publications

References 29 publications

The Role of Anticoagulation in Tumor Thrombus Associated with Renal Cell Carcinoma: A Literature Review

The Role of Anticoagulation in Tumor Thrombus Associated with Renal Cell Carcinoma: A Literature Review

Management of Renal Cell Carcinoma With Supradiaphragmatic Inferior Vena Cava Thrombus Diagnosed During Acute COVID-19 Infection

Mayo Adhesive Probability Score Does Not Have Prognostic Ability in Locally Advanced Renal Cell Carcinoma

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